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Aqueous Humor

the rate of production is equal to the rate of outflow which helps to maintain IOP within a normal range.


eye disease that is caused by the increased IOP which causes damage to the optic nerve & results in gradual loss of vision with rush for complete blindness.

Intraocular Pressure

average level 15-16 mmHg
IOP >21 = abnormal & increased risk for glaucoma
IOP >31 = requires treatment because they are associated with changes in vision

Drug Therapy for Glaucoma

some drugs used take 6-8 weeks to reach their peak values & some have effects 2-4 weeks after drugs have been discontinued.

Two Mechanisms of Action

1. Increasing the outflow of aqueous humor
2. Decreased the formation of aqueous humor

Routes of Administration

1. topical - most frequent
2. orally - for severe disease

Prostaglandin Facts

drug of choice, longer duration of action, fewer side effects, used alone and with beta blockers

Prostaglandin Action

enhance the outflow of aqueous humor

Prostaglandin Drug

Latanoprost (Xalatan) - eye drop solution

Prostaglandin Side Effects

1. Heightened pigmentation which turns the blue iris to a brown color
2. May be irreversible
3. Thicker and longer lashes
4. During the first month of therapy...
a. local irritation of the eye
b. stinging of the eye
c. redness
*Because of the effects, normally administered just before bedtime.

Autonomic Drugs

Beta Blockers, Alpha Agonists, Cholinergic Agonists, Non-selective Sympathomimetics, Carbonic Anhydrase Inhibitors, Osmotic Diuretics

Beta Blocker Facts

"olol" drugs, can lower the IOP by 20-30%, produce fewer ocular effects than autonomic drugs: local burning & stinging, blurred vision

Beta Blocker Action

decrease the production of aqueous humor

Beta Blocker Drug

Timolol (Timoptic) - applied topically (eye drops/opthalmic solution)

Beta Blocker Side Effects

Usually there is not a significant amount of systemic absorption, but if there is:
1. bronchoconstriction
2. dysrhythmias
3. hypotension
*Use caution in patients with asthma and heart failure

Alpha Agonist Facts/Action

"nidines", decrease production of aqueous humor, not frequently prescribed, applied topically (eye drops/opthalmic solution)

Alpha Agonist Drugs

Apraclonidine (Iopidine) - reduced IOP during or following eye surgery
Brimonidine (Alphagan) - adjunct therapy in combination with glaucoma drugs

Alpha Agonist Side Effects

headache, drowsiness, dry mucous membranes, blurred vision, irritated eyelids

Cholinergic Agonist Facts/Action

produce miosis (constriction of the pupil), contracts the ciliary muscle, this allowed greater outflow of aqueous humor and lowering IOP, applied topically (eye drops/opthalmic solution)

Cholinergic Agonist Drug

Pilocarpine (Isoptin-Carpine, Pilopine) - (eye drops/opthalmic solution)

Cholinergic Agonist Side Effects

headache, induced myopia (constriction of pupil), decreased vision in low light

Cholinergic Agonist Toxicity

Occurs with systemic absorption:
salivation (increased), tachycardia, hypertension, bronchospasm, sweating, nausea, vomiting

*Because of the greater toxicity, cholinergic agonists are normally used only in patients with open-angle glaucoma who do not respond to other drugs

Non-selective Sympathomimetics Facts/Action

produces mydriasis (pupil dilation) - increases the outflow of aqueous humor resulting in decreased IOP, not as effective as beta blockers or prostaglandins

Non-selective Sympathomimetic Drug

Dipivefrin HCL (Propine) - applied topically

Non-selective Sympathomimetic Side Effects

1. local burning and stinging
2. blurred vision
3. headache
4. photosensitivity (because of dilation)

Non-selective Sympathomimetic Adverse Effects

converted to epinephrine and effects are identified to epinephrine, if reaches the systemic system it will increase the blood pressure and heart rate, because of the systemic effects they are rarely used

Carbonic Anhydrase Inhibitor Facts/Action

"zolamide", given topically or orally (systemically), decreases the production of aqueous humor

Carbonic Anhydrase Inhibitor Drugs

Dorzolamide (Trusopt) - topical
Acetozolamide (Diamox) - oral (systemic)

Carbonic Anhydrase Inhibitor Side Effects

Dorzolamide (Trusopt)
-fewer except for photosensitivity
Acetazolamide (Diamox)
-effective at lowering IOP but produces more systemic effects than other classes.
*lethargy, nausea/vomiting, depression, paresthesias, drowsiness

-contain sulfur and may cause an allergic reaction
-oral forms are diuretics so electrolytes and I&O must be monitored because they can reduce IOP quickly

Osmotic Diuresis Facts/Action

given orally or IV, quickly reduces plasma volume, effective in reducing the formation of aqueous humor, used prep and postop with ocular surgery, emergency treatment for acute closed-angle glaucoma

Osmotic Diuresis Drugs

Isosorbide (Ismotic)
Mannitol (Osmitrol)

Osmotic Diuresis Side Effects

headaches, tremors, dizziness, dry mouth, fluid and electrolyte imbalances
*can cause thrombophlebitis and venous clot formation near the IV site
(at risk for dehydration & electrolyte imbalances)

Drug Therapy for Eye Exams

Mydriatics and Cyclopegics

Mydriatic Drugs Facts/Action

dilate the pupil to allow better assessment of the retinal structures, the response can last 3 hours up to several days

Mydriatic Drug Side Effects

cause intense photophobia and pain in response to light; can worsen glaucoma by impairing aqueous humor outflow and increasing IOP

Mydriatic Drug

Phenylephrine (Mydfrin, Neo-Synephrine) - available in eye drops

Cycloplegic Drugs Anti-cholinergic Facts/Action

dilate the pupil, paralyze the ciliary muscle, prevent the lens from moving during assessment

Cycloplegic Drug Side Effects

cause severe blurred vision and loss of near vision;
the response can last 3 hours up to several days

Cycloplegic Drugs

Atropine (Isopto Atropine)
Cyclopentolate (Cyclogyl, Pentolair)
-available in eye drops

Mydriatic & Cycloplegic Patient Teaching

*wear sunglasses
*ability to drive, read, and perform visual tasks will be affected during the treatment.

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